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Kidney preservation protocol for management of emphysematous pyelonephritis: Treatment modalities and follow-up.

El-Nahas AR, Shokeir AA, Eziyi AK, Barakat TS, Tijani KH, El-Diasty T, Abol-Enein H - Arab J Urol (2011)

Bottom Line: After initial resuscitation, ultrasonography-guided percutaneous tubes were placed for drainage of infected fluid and gas.A radio-isotopic renal scan was done after stabilization of the patients' condition.The overall mortality rate was 7% (two patients).

View Article: PubMed Central - PubMed

Affiliation: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

ABSTRACT

Objectives: To present treatments for kidney preservation in the management of emphysematous pyelonephritis (EPN), and to evaluate the functional outcome of preserved kidneys during the follow-up.

Patients and methods: The computerized files of patients with EPN from 2000 to 2010 were reviewed. After initial resuscitation, ultrasonography-guided percutaneous tubes were placed for drainage of infected fluid and gas. A radio-isotopic renal scan was done after stabilization of the patients' condition. Preservation of the affected kidney was attempted when the differential function was >10%. A renal isotopic scan was taken during the follow-up to evaluate renographic changes in preserved kidneys.

Results: The study included 33 kidneys in 30 consecutive patients (mean age 51.7 years, SD 10.9). Kidney preservation was applicable for 23 kidneys (20 patients). Preservation methods included percutaneous nephrostomy for 12, percutaneous tube drain for two and conservative treatment for nine kidneys (six patients). Nephrectomy was performed for 10 kidneys (emergency in three and delayed in seven). The frequency of post-treatment septic shock after kidney preservation (10%) was significantly lower than after nephrectomy (20%, P = 0.005). The overall mortality rate was 7% (two patients). The follow-up was completed for 13 patients with 15 preserved kidneys for a mean duration of 21 months. During the follow-up, differential renographic clearance of the affected kidney was stable in 13 of 15 while two kidneys showed improvement.

Conclusions: Kidney preservation should be the primary goal in the treatment of EPN when the differential renal clearance is >10%. It was associated with fewer complications than nephrectomy and the follow-up showed a favourable functional outcome of the preserved kidneys.

No MeSH data available.


Related in: MedlinePlus

NCCT (axial scan) showing extensive gaseous collection affecting the parenchyma of the left kidney and extending to the para-renal space (class IIIb).
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f0005: NCCT (axial scan) showing extensive gaseous collection affecting the parenchyma of the left kidney and extending to the para-renal space (class IIIb).

Mentions: Kidney preservation was attempted for 23 kidneys in 20 patients; preservation methods included PCN for 12 kidneys, conservative (medical) treatment for nine (six patients) and PCDs for extensive para-renal gaseous collection in two (Fig. 1). Nephrectomy was used for 10 kidneys (emergency in three and delayed after PCN in seven). Table 2 summarizes the results of the univariate statistical analysis of risk factors for nephrectomy. Thrombocytopenia was the only statistically significant factor (P = 0.009) on univariate analysis, but there was no significant factor on multivariate analysis.


Kidney preservation protocol for management of emphysematous pyelonephritis: Treatment modalities and follow-up.

El-Nahas AR, Shokeir AA, Eziyi AK, Barakat TS, Tijani KH, El-Diasty T, Abol-Enein H - Arab J Urol (2011)

NCCT (axial scan) showing extensive gaseous collection affecting the parenchyma of the left kidney and extending to the para-renal space (class IIIb).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150599&req=5

f0005: NCCT (axial scan) showing extensive gaseous collection affecting the parenchyma of the left kidney and extending to the para-renal space (class IIIb).
Mentions: Kidney preservation was attempted for 23 kidneys in 20 patients; preservation methods included PCN for 12 kidneys, conservative (medical) treatment for nine (six patients) and PCDs for extensive para-renal gaseous collection in two (Fig. 1). Nephrectomy was used for 10 kidneys (emergency in three and delayed after PCN in seven). Table 2 summarizes the results of the univariate statistical analysis of risk factors for nephrectomy. Thrombocytopenia was the only statistically significant factor (P = 0.009) on univariate analysis, but there was no significant factor on multivariate analysis.

Bottom Line: After initial resuscitation, ultrasonography-guided percutaneous tubes were placed for drainage of infected fluid and gas.A radio-isotopic renal scan was done after stabilization of the patients' condition.The overall mortality rate was 7% (two patients).

View Article: PubMed Central - PubMed

Affiliation: Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

ABSTRACT

Objectives: To present treatments for kidney preservation in the management of emphysematous pyelonephritis (EPN), and to evaluate the functional outcome of preserved kidneys during the follow-up.

Patients and methods: The computerized files of patients with EPN from 2000 to 2010 were reviewed. After initial resuscitation, ultrasonography-guided percutaneous tubes were placed for drainage of infected fluid and gas. A radio-isotopic renal scan was done after stabilization of the patients' condition. Preservation of the affected kidney was attempted when the differential function was >10%. A renal isotopic scan was taken during the follow-up to evaluate renographic changes in preserved kidneys.

Results: The study included 33 kidneys in 30 consecutive patients (mean age 51.7 years, SD 10.9). Kidney preservation was applicable for 23 kidneys (20 patients). Preservation methods included percutaneous nephrostomy for 12, percutaneous tube drain for two and conservative treatment for nine kidneys (six patients). Nephrectomy was performed for 10 kidneys (emergency in three and delayed in seven). The frequency of post-treatment septic shock after kidney preservation (10%) was significantly lower than after nephrectomy (20%, P = 0.005). The overall mortality rate was 7% (two patients). The follow-up was completed for 13 patients with 15 preserved kidneys for a mean duration of 21 months. During the follow-up, differential renographic clearance of the affected kidney was stable in 13 of 15 while two kidneys showed improvement.

Conclusions: Kidney preservation should be the primary goal in the treatment of EPN when the differential renal clearance is >10%. It was associated with fewer complications than nephrectomy and the follow-up showed a favourable functional outcome of the preserved kidneys.

No MeSH data available.


Related in: MedlinePlus